Diabetes Self-Management Blog

Recently, I was reading some of the readers’ postings on this Web site. Some of these postings expressed fairly strong opinions about how one should best manage his or her diabetes. Of course, one of the many good things about living in the United States is our right to freedom of speech, and postings such as these certainly get people thinking. However, it’s all too common for misconceptions about diabetes to abound. Whether it’s the belief that eating sugar causes diabetes, or that starting on insulin can make you go blind, or that having to start taking diabetes pills or insulin means that you’re a “bad diabetic,” as a dietitian and diabetes educator, I feel compelled to set the record straight whenever I can.

So, what’s the best way to control diabetes? When it comes to Type 1 diabetes, which accounts for 5% to 10% of all diabetes cases, that’s a no-brainer. A person with Type 1 diabetes must take insulin to survive. His pancreas has—to put it
simply—”pooped out,” meaning that it no longer makes enough insulin. Of course, a person with Type 1 diabetes has choices as to how he takes insulin. The choices nowadays range from the traditional vial and syringe to an insulin pen to an insulin pump to an inhaler. The future holds more possibilities for insulin delivery as well. People with Type 1 diabetes must still incorporate meal planning and physical activity into their daily management.

About 90% to 95% of people with diabetes have Type 2. But Type 2 diabetes is a little less clear-cut in terms of how it’s best managed. The reason is that Type 2 diabetes is a progressive condition. When someone is first diagnosed with Type 2 diabetes, the cornerstones of management are often, initially, what many health-care professionals term “diet and exercise,” or, more appropriately, “lifestyle changes.” In other words, a person in the early stages of Type 2 diabetes may be able to control his blood glucose levels nicely by following a carbohydrate- and calorie-controlled meal plan, losing some weight (if necessary), and fitting regular physical activity into his or her schedule. At this stage of the game, the body is still making enough insulin, and healthy eating and activity help the body use its own insulin quite efficiently.

Over time, however, diabetes progresses, and lifestyle changes simply aren’t enough anymore to control blood glucose levels. At this point, a person with Type 2 diabetes will likely need to start taking medicine in addition to continuing with those healthy lifestyle changes. Medicine is usually in the form of one or more diabetes pills. Many people with Type 2 eventually go on to require insulin.

People with diabetes often feel like they’ve failed because they have to go on diabetes drugs. The truth is that their pancreases have failed them. It’s not their fault. If you’re looking to place the blame on someone, look to your family tree. Genetics plays a big factor in who gets Type 2 diabetes and who doesn’t.

The natural course of Type 2 diabetes is for it to progress to a point where, if the person lives long enough, he or she will have to take insulin. No one is to blame, nor is eating that piece of cheesecake or failing to take a walk after supper. There’s evidence that incorporating healthy lifestyle behaviors may stave off the need to take medicine or insulin for a while, and it’s important for people with Type 2 diabetes to work with their health-care teams on these behaviors. But the bottom line is that Type 2 diabetes will eventually take its course. Family, friends, and coworkers can best help the person with Type 2 diabetes by being supportive and encouraging instead of being hurtful or disparaging.

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Comments
  1. Hi Amy - I am looking for feedback on what I perceive to be incorrect information in the July/August issue of this magazine.
    It was a quiz on glucose management and the question was #2: If your blood glucose level is high first thing in the morning, which of the following reasons may explain why?
    One of the correct answers listed was A. late night eating.
    UGH!!!! My understanding of physiology is that a meal is gone in 4-6 hours and could not possibly be the cause of high am sugars. If they meant a snack at 2am, they should have specified this.

    If you have feedback, I would love to hear it. This is only my second time blogging, so would you use my e-mail if you respond so that I can see it? Many thanks for your column and your time :)

    Posted by Emily Evina-Ze |
  2. Hi Emily,
    Thanks for your question. In actuality, the answer is correct–eating before bedtime can sometime cause fasting blood glucose levels to be higher than usual. While it’s true that most food is digested within 2-6 hours, if someone eats a particularly large “snack” (that is more like the size of a meal), or if the snack happens to be somewhat high in fat, digestion may last a little longer, and this, in turn, can cause higher readings in the morning. Another factor is the timing of the bedtime snack; there’s certainly a difference between eating a snack at 9 PM vs. at midnight, for example.

    One other reason for high morning blood glucose levels that wasn’t mentioned in the article is the possibility that someone who takes insulin is having hypoglycemia in the middle of the night. The high blood glucose the next morning may be due to a “rebound” from the low blood glucose. If there’s any possibility of this happening, it’s important to set the alarm and monitor at 2 or 3 AM.

    Posted by acampbell |
  3. Man when I was first diagnosed with Type 2 I was well into the disease and was put on Metformin. At first I did real well I exercised at least 30 minutes 5-7 days a week and cut out all of the carbs. However I trael for a living and it became harder and harder to get he exercise and to stick tot eh strict diet I had imposed on myself. Now I’m one of those all or nothing people. Either I do it all or I find value in none of it. SO as my diet slipped a little and my exercise started to wane I quit both and returned to my old ways. I know deep down that I have to do something but I can’t get started again. I guess if I get 10 more years of living happily instead of 20 years of being miserable its worth

    Posted by Kelly |
  4. I question that diabetes is progressive. Lots of people stay using activity and food choices to manage their diabetes. The only time I see a progression is once meds are introduced. Its like the person needs more and more meds and rarely do I see anyone have good control with meds. I think like most drugs, your body gets use to it so it thereby simply requires more and more to achieve the same affect.

    I would like to see diabetics educated in self management instead of medication dependancy to maintain control. Its certainly healthier and also enpowering, creating less depression and hopelessness.

    I also take offense when medical personal demean the hard work of D&E controled diabetic by stating that the reason they have control is that they are in the intial stages of a progressive disease.

    On one hand we are told to not be fat and control out choices so we can have good BS readings, and then when we do, we are told we must not really have the disease. Its interesting.

    Posted by SUSANNAH |
  5. I’m new at being a diabetic and to read the article diet and exercise,sure leaves one feeling hopeless. I have read allot of books on the subject and think that I can controll my health and diabetes with diet, exercise and Metformin. Maybe I’m wrong, but I sure think I deserve the right to try. According this article and you it’s not possibible. Not sure I like this magazine yet. Thanks for nothing.

    Posted by Bert |
  6. Hi Bert,
    I’m sorry if you’re feeling hopeless about your diabetes. There’s a very good chance you’ll be able to control your diabetes through meal planning, weight control, physical activity and metformin. However, it’s important that people with type 2 diabetes be aware of their condition, meaning that, because it does progress, they MAY need to eventually start insulin. A lot of people feel bad about themselves if this happens, and the point of my blog was to help allay the guilt that often accompanies insulin initiation. If you can control your diabetes with your current treatment plan, there’s every reason to be optimistic that you’ll continue to do so.

    Posted by acampbell |
  7. Hi Susannah,

    You’re right - many people are able to manage their diabetes through meal planning and physical activity. However, there are many people who need - and do well with - medication, whether that be pills or insulin. The bottom line is really how well a person’s diabetes is controlled, and that’s primarily determined by their A1C level and presence or absence of complications. And I agree with you that people with diabetes need education in self-management. Unfortunately, many people don’t have the opportunity to receive diabetes education. Hopefully this will change. And while you may encounter medical personnel who demean the hard work you’re doing, I can assure you that most diabetes educators do not. As a dietitian, I’m always impressed and encouraged when people are following and doing well with their meal plan and physical activity plan. Hopefully you’re doing well with yours!

    Posted by acampbell |
  8. I have reading a new book “Reverse Diabetes Now” by Dr. Neal Barnard. In his book he says that a vegan diet, no animal products, will reverse or greatly reduce the need for medication in cases of Type 2. Can you tell me if this is possible?

    Posted by Bill Buck |
  9. my fiance was just diagnosed with diabetes i am really scared i hear you can control it with meals, exercise, and just controling your blood sugar. We are both really scared and not really sure how to take this? we have 5 kids and a great life we dont want this to put a pitfall in our lives please give me some advice with being so young and dealing with this new situation.

    Posted by angela |
  10. how long does a person have to live after being diagnosed with diabetes? is there a certain length of time or is it all up to the person and the medication? I am so scared and i am not even the one with the diabetes. if you have it at the age of 38 whould you still live to be atleast 90 or so. god i am really scared for our family and when you say it will take it course is that like cancer eventually no matter what you do it will soon make you so sick that you will die.

    Posted by angela |
  11. Hi Angela,

    While it can be scary at first to find out that someone you love has diabetes, the good news is that, today, there are so many effective treatments, such as medications, a healthy eating plan, and physical activity, that you can live a long, healthy life with diabetes. In fact, many people with diabetes are actually healthier, in many ways, than some people without diabetes. This is because they take such good care of themselves. But it’s normal to be overwhelmed in the beginning. That’s why it’s important to learn as much as you can about the best way to treat diabetes. Your fiance may need medication, or may be able to control his diabetes with meal planning and regular activity. I’d recommend that you and your fiance talk with his doctor and meet with a diabetes educator or attend diabetes classes at your local hospital, for example. Read the postings on this website. The more you know, the less scary it will be. Good luck!

    Posted by acampbell |
  12. I was diagnosed this week. My A1c was 6.5. Doc wants me to control w/ diet & exercise only. He doesn’t have me checking levels…only every 3 months.No meds other than thyroid, blood pressure/diuretic, & arthritis. How can I make the biggest difference by the time those 3 months roll around? What’s the BEST BREAKFAST to set me up for the rest of the day? I am frightened beyond belief of needles & can pass out when blood is drawn. I am unreasonably fearful of what this disease will do to my life & I can feel depression creeping up around me. I am usually very upbeat, positive & happy person.I’m unhappy now. I am 56 & need to lose that many pounds. I finally found an arthritis med that will alleviate pain enough to allow me to walk for exercise. Is it unreasonable to think that diet & exercise can make enough difference to reverse my situation? to prevent having to ck more than ea. 3 mo.? Please, what is reasonable to hope for. Thanks in advance for your considered responses.

    Posted by lisateacher |
  13. Where do I check for my postings and any possible responses? I am having a very rough time today and hope someone might respond!! Thank you.

    Posted by lisateacher |
  14. Hi lisateacher,

    Comments on this site are usually moderated Monday through Friday, so if you post over the weekend there can be a slight delay before your comment shows up. You can check back at this page or keep an eye on the “Recent Comments” box on the blog homepage () to look out for responses.

    Meanwhile, you may want to check out Amy Campbell’s entries Getting Off to a Good Start with Breakfast: Part 1 and Getting Off to a Good Start with Breakfast: Part 2 for tips on healthy breakfast choices!

    Posted by Tara Dairman, Web Editor |
  15. Hi lisateacher,
    It certainly can be scary, confusing and even depressing when you’re diagnosed with diabetes. It may help to focus on the positive, though - namely, that your A1C is excellent (the goal for most people with diabetes is less than 7%). Your doctor most likely feels that making some changes in your eating and activity, and losing a little weight can help you control your diabetes. I’d suggest you make an appointment with both a diabetes educator and a dietitian - learn all you can about what you can do to manage your diabetes. Go to http://www.diabeteseducator.org/DiabetesEducation/Find.html to find an educator in your area.

    Posted by acampbell |
  16. I know a person with a type 2 diabetes condition. First time he was diagnosed with FBS 176, on the next day it was 165- then after five days it was 144. After a week it became 60, then in all other cases below 100. In some instances 100-110. He is in this situation fort half a year. Is he a diabetic?

    Posted by Timeless Truth |
  17. Hi Timeless Truth,
    I can’t really make a diagnosis for your friend. I’m assuming that his blood glucose levels were done in a lab (and all at the same lab)and not on a meter. Technically, diabetes is diagnosed when a FBS is 126 or higher and the result is repeated on a different day. However, now that his FBS are hovering around 100, it seems like he might have pre-diabetes. He should continue getting his glucose levels checked, and also discuss his results with his healthcare provider. And in the meantime, encourage him to focus on a healthy eating plan, staying at a healthy weight, and being physically active most days of the week.

    Posted by acampbell |
  18. A year ago, I was diagnosed as a diabetic.

    my A1C was 10.2 +/-

    My endorinologist advised me to go on insulin immediately. I was heartbroken. I have seen my relatives all have deteriorated health becasue if Type 2.

    I begged him to let me attempt to lose that extra weight and see if I could lower it naturally.

    I lost 40 pounds within 6 months.

    My following A1Cs were

    Initial - 10.2
    3 mo - 7.2
    6 mo - 5.2
    9 mo - 5.1
    1 year - 5.0

    No meds, no insulin. My highest glucose reading is about 150 (after meals) and my highest fasting reading is 105 (ranges from 70-105)

    During this whole time, my endocrinologist advises me to go on meds. Now he is telling me that I should go on Januvia…in part becasue he believes that i will one day have more problems. I have resisted this long, and feel that he may just be a prescription pusher. Am I unreasonable to think that I can deny diabetes at the gate?

    Posted by michael weinstein |
  19. Hi Michael,
    First, I’d like to congratulate you. You’ve done an awesome job making lifestyle changes, as evidenced by your weight loss and your A1C levels. Different healthcare providers have different opinions, obviously, on the best way to manage type 2 diabetes. One of the endocrinologists that I work with believes it’s all in the numbers; meaning, that since your A1C is at (and even below) goal (less than 7%), what you’re doing is working, and that there’s no need to change your treatment plan. Perhaps have another talk with your doctor and make a deal: as long as your A1Cs stay at or under your target range, you’d like to hold off on taking diabetes medication. Also, there is some evidence that taking metformin or pioglitazone may help stave off diabetes; I’m not sure that Januvia does the same. Good luck!

    Posted by acampbell |
  20. I have had Type 2 Diabetes for 4 years. I am 65. No meds yet but numbers are creeping up. I walk 3 miles a day. Now I am having the high morning numbers and am very confused by the yes exercise no don’t do a LONG walk. Confused by the have a snack don’t have a snack!!!! Very depressing. Where do I go for ACCURATE advise tht I can actually use?

    Posted by Lee |
  21. Hi Lee,
    That’s great that you’re walking 3 miles per day. I can understand your frustration when you’re doing everything “right” and yet you’re seeing your blood glucose numbers climb up. Since your morning (and I assume you mean fasting) glucose numbers are on the high side, first think about what you’re eating at night. Do you eat a late supper? Are you snacking before bed? Do you think you’re eating too much carbohdyrate? Since you’re not taking medication, you don’t need to eat snacks, since you’re not at risk for low blood glucose. If you want to eat a snack, try to go for lower carb choices, such as nuts or lower-fat cheese, for example. You might try doing your walking after supper, if possible, which can also help lower fasting glucose. And think about asking your physician for a referral to a diabetes educator in your area (they usually have the CDE credential, which stands for Certified Diabetes Educator). You can also find one in your area by calling 1-800-338-3633.

    Posted by acampbell |
  22. Thanks acampbell. I have been walking after supper and now am wondering if what is happening is the “Dawn thing” where a person goes low during the night because of exercise. So, I am going try and check my blood at about 3 am for a couple of nights.

    Posted by Lee |
  23. Hi Lee,

    It’s a good idea to check and see what’s happening overnight. The dawn phenomenon actually is an increase in blood glucose levels in the early morning hours, and occurs due to glucose release from the liver. This is very common in people with type 2 diabetes. Some of the suggestions I gave you earlier may help. Sometimes medication is needed at bedtime, as well.

    Posted by acampbell |
  24. Thanks again acampcell
    I have an appointment today to talk to a Diabetes Dietician.

    I need to get a good sense of direction here and I go back to my Doctor in a couple of weeks.

    Right now I am not on any meds and I sure would like to keep it that way.

    Posted by Lee |
  25. Hi Lee,

    I’m glad you’re going to see a dietitian and I hope all goes well for you. Let me know how you make out.

    Posted by acampbell |
  26. acampbell

    - thanks - I found out that I was not eating ENOUGH carbs plus I was walking 3 miles - so my numbers were all over the place

    She explained that a woman needs 3 to 4 servings of carbs per 1/3 of the day. That 15 carbs= 1 serving. Since I have been careful with my carbs my numbers are stabilizing again.

    Hope to stay off meds for as long as I can.

    Posted by jfortmann |
  27. Hi

    I am 42 yrs old South Asian male, diagnosed with high BG about 6 months back, which I am controlling with diet and exercise so far.

    I have lost about 9kg since then, bringing my BMI down from 28 to nearly 25. My Hba1c has come down from 13.4 to 7.3 in 3 months and is around 6 now. I monitor my BG regularly at home, and my FG still ranges around 6.2 - 6.5, 2 hr PP around 7.5 - 9.0.

    However, every now and then I have a sudden feeling of nervousness and anxiety (similar to a hypoglycemic episode) that goes away on sucking on a candy. It mostly happenes about 3 hrs after breakfast. Interestingly, my BG always comes out normal during these episodes.

    I also feel a bit weird after meals esp. lunch and the feeling goes away after 15-20 minutes. Can anyone help me understand what is happening to me? Should I be doing more than my daily 1 hour brisk walk and 1200 cal low-carb diet?

    Would appreciate all advise…

    Posted by sherman |
  28. Hi Sherman,
    First, congratulations! Your hard work and efforts have certainly paid off, given your A1C, glucose and weight loss results. As far as your symptoms of nervousness and anxiety, while they can be symptoms of hypoglycemia for some, it’s unlikely that you’re going low, since you don’t take medication for diabetes and these episodes occur after eating. You mentioned that your glucose levels are “normal” when you’ve checked at these times - what is considered “normal” for you? You could be getting these symptoms if your glucose is spiking up too high. On another note, a 1200 calorie diet is actually quite low for a man, so you may not be consuming enough food, particularly enough carbohydrate. You might consider boosting your calories closer to 1500-1800. It’s also possible that your symptoms aren’t related to your diabetes. If they continue, please discuss them with your physician.

    Posted by acampbell |
  29. I am also new to diabetes. My doctor had been watching my sugar levels for the last two or so years. Until this year, he had me in the pre diabetes class. In July my numbers were 7.3. He now has me on a three month watch. In September my numbers had dropped to 6.1. I go back for another round in December. At this point I’m just doing diet and exercise. I’m 66 years old and my goal is to not have to go on medication. I have lost 15 pounds at this point by cutting out most of my carbs, he said if I could lose another 25 it might just solve my problem.

    I’m trying to really keep my carbs under control. So far he has me testing twice a week. I have chosen to do so in the morning before I eat. Is this enough? When is the best time to test? I won’t see him again until December. I also test occassionally at different times during the day to see what’s going on. After eating, how can I know what would be too high numbers?

    Posted by Dian |
  30. Hi Dian,

    Sounds like you’re doing very well with your diabetes! As far as testing, or checking, goes, your best bet is to vary the times when you check. If you only check in the morning before eating, you’ll miss other times of the day, including after meals, when your blood glucose may be higher (or lower). I’d suggest you vary the times: alternate by checking before each meal over a few days, and then check two hours after meals and before bedtime on other days. Fasting and pre-meal blood glucose targets are 70-130, and 2 hours after meals, no higher than 180. Bedtime readings should be around 110-150. However, your A1C is really the more important number, as that tells you how your blood glucose has been doing over the past three months. The goal is to keep your A1C under 7% — so you’re on the right track!

    Posted by acampbell |
  31. Thank you, that was very helpful to me

    Posted by Dian |
  32. As a type 2 diabetic my experience has been that the disease does not have to be progressive or that diet and exercise is only effective in the early stages of the disease for quality control.

    I used to use 300 units of insulin via an insulin pump every day and needed a continous glucose monitor. Which means my insulin resistance was about as bad as it could get. Now, a year later, I have better control and do not need any insulin. Which basicly means I now have much less insulin resistance.

    My triglcerides were over 5000 while on four diffrent meds. I even needed plasma pheresis weekly for about a year to keep it at this level. Now on a lower dose and only 3 meds my last triglceride level was 147.

    I accomplished this by eating a healthy balanced diet, counting calories not carbs and daily exercise of a significant intensity for at least 30 minutes. The net result has been a 82 pound weight loss and still droping.

    The real question people should be asking themselves is how many type 2 diabetics they know that can run 4 miles still need insulin.

    I suggest you try a 1500 calorie restriction for men and a 1200 calorie restriction for women with daily exercise of some intensity before you declare that the disease is by it’s nature progressive or that diet and exercise is only effective in the early stages.

    Posted by Nurse Paul |
  33. Nurse Paul,

    Thanks for your posting. You’ve done remarkably well and hopefully are an inspiration to others with Type 2 diabetes. However, Type 2 diabetes is characterized by beta cell failure over time, resulting in insulin resistance. The fact is that most people with Type 2 diabetes eventually need to take medicine to help manage their glucose and insulin resistance. There are always exceptions, of course. And I wholeheartedly agree with you that lifestyle approaches (a healthy eating and activity plan) can make a big difference in not only who gets diabetes in the first place, but how well it’s managed after diagnosis. But we also know that many people go a very long time before being diagnosed with diabetes; at that point, they may need to start medicine right away. And my experience as a dietitian is that 1500 calorie and 1200 calorie eating plans tend to not be realistic for most people, long-term. Having to take medicine is not a sign of failure. We certainly wouldn’t tell someone with Type 1 diabetes that having to take insulin isn’t a good thing. The point is to find a treatment plan that works and that is manageable. That will vary from person to person, too.

    Posted by acampbell |
  34. I started on thryoid meds because my doctor said it was on the high side of low ….no problems…they did blood work found that my AiC was 7.8…he still did not put me on meds - my primary got the results and put me on meds immediately. Three days now and it is a living hell. Nausea, diaherra, GI problems, swollen hands and feet, blood level is all over the place. My first AIC 6.5 - BSL was 134 - it was l34 at the doctor and she still put me on meds. She said no carbs - your’s is early enough that with losing weight I could reverse this and come off my pill Metformin. Is this not true? I am going to meet with a dietician and have a 3 hour gluscos test.

    Posted by Nancy Adams |
  35. Hi Nancy,

    I’m glad to hear that you’ll be meeting with a dietitian. Getting an individualized meal plan can help you better manage your diabetes and lose weight. The goal, by the way, is not a “no carb” diet, but rather, an eating plan that is controlled in carbohydrate. You still need to eat some carbohydrate for energy and overall health. It sounds like you’re experiencing some typical side effects from metformin. It may be that you need to start with a lower dose, and if necessary, gradually increase. However, it’s possible that with a healthy eating plan, a little bit of weight loss, and physical activity (at least 30 minutes per day), you could come off the metformin or be on a lower dose. The best gauge of how your treatment plan is working is looking at both your day-to-day glucose readings (70–130 before meals) and your 3-month A1C (goal less than 7%).

    Posted by acampbell |
  36. Hi

    on 30th of march my A1C was 8.6 & three hrs after food level was 120 (lab test), doctor told me that i am diabetic……

    i was in a bad & irregular routine for 3-4 months till 30th of march no regular sleep & having junk food, working day/night

    from 1st april i started good controlled diet & yoga & 21st of april i had home test fasting 100 & 2 after good lunch was 150….

    am i really dibetic, i am 34 yrs male with no family history of diabetes…..

    please help

    thanks
    akaash

    Posted by akaash |
  37. Hi akaash,

    It’s a little too soon to say whether you have diabetes or not…and not necessarily a black or white answer, either. The fact that your A1C was 8.6 could be indicative of diabetes, but the good news is that you’ve been working hard to lower your blood glucose levels. You should talk with your doctor, of course, but I’d suggest that you have your A1C checked again in about 3 months. The A1C can now be used to diagnose diabetes; a level of 6.5 or higher is indicative of diabetes. Also, although you don’t have a family history of diabetes, there are other risk factors for diabetes, including being overweight, lack of physical activity, high blood pressure, and high lipid (cholesterol) levels.

    Posted by acampbell |
  38. Thanks for your reply……

    i am really confuse in between a controlled state with diet & exercise or not having the desease or cured…..

    since april 21, i am checking the sugar levels 3-4 times a day, most of them are normal & one or two were slightly high in prediabetes zone…

    so if i get a normal A1C in 3 months times, with all other test are normal,will i be still diabetic all my life….

    the only thing was last A1c was higher could it be a temperory thing coz of lack of sleep and over eating
    ? olso is there any other test like insuline level etc. to diognose it ?….i have read some websites , they say it is a honeymoon period of few months &
    ultimately you have take medicines and insuline as well…..
    please help

    Posted by akaash |
  39. Hi akaash,

    Again, it’s hard to say for sure. Sometimes things aren’t black or white. I’m not aware of a connection between lack of sleep or overeating and a high A1C. If you get your A1C checked again in 3 months and it’s above 6.5, you may have diabetes. If it’s between 5.7 and 6.4, you likely have prediabetes. You can have an oral glucose tolerance test done, as well; this is another method of diagnosing diabetes.

    Posted by acampbell |
  40. I learned of my Pre-Diabetes stage first through a blood test at work but didn’t believe the test. I did weight lifting and was on a good cardio program. However, my goal was to get bigger (muscles) so I ate good food but a lot of it. Hence, I was in the Pre-Diabetes stage. A year later I began taking care of my Dad who began early stages of Dementia. (His diabetes was mostly uncontrolled although he took meds, he didn’t watch his diet or exercise at all.) As I took care of him I learned my blood test the year before was accurate because I checked my fasting glucose level a few times with Dad’s meter (120). I now have my BMI within range and my fasting glucose readings are never above 95…Mostly I can keep them in the upper 80’s and if I do real well in the lower 80’s all with Diet and Exercise.
    Reading this article and posts, it does seem that this disease will progress to where I will have to take meds some day (I’m 52 now). I’ve notice some and even you seem to take the stance that insullin is a step after oral meds. It seems to me that insullin is the most natural way to control diabetes since this is what the body produces. I’ve also heard that oral meds are hard on the organs and insulin is a better choice. I had in my mind if I progress to where I require meds, I was going to go with insulin and administer it as my body would…after I eat. This would also help me to eat better because the worse I ate the more insulin I would require.
    What do you think?

    Posted by Don |
  41. Hi Don,

    You’ve been doing a great job taking care of yourself (on top of taking care of your father!) and hopefully you can continue to control your glucose with exercise and healthy eating for a long time. However, there may come a day when you will need medicine. There are so many options now (and more in the pipeline), and there’s really no one right approach. You’re right, though, in that many people don’t realize that insulin is one of the most natural medicines that we have and with the fewest side effects, too. It’s often the fear of injections that stop people from starting on insulin earlier. If you need to start on medicine, insulin could certainly be a great choice for you. Taking it after a meal could work, but you might find that you’d need some premeal, too, which would better mimic the way the pancreas works. So, see what happens, and thanks for your question!

    Posted by acampbell |
  42. Hi, I just learned I have diabetes early in March. I have really stepped up my exercise and am on a diabetes diet. My blood sugars have been much more normal the last 3 weeks. However, it seems they usually soar after dinner (my largest meal). I can be 100 or so before dinner,then go up to around 200 sometimes, and this makes me very frustrated, as I feel like I have changed my lifestyle a lot. I will have my first 3 month visit with my doc June 15, and I am thinking when he sees these high evening numbers, he will want me to go on medication, and I will feel disappointed in myself if he does that. I have lost about 15 pounds since starting this, and am continuing to lose. I am hoping as I continue to stay fit (I was not exercising much before, that my body will control my sugar level better. What is your opinion?

    Posted by Stephanie |
  43. Hi Stephanie,

    It sounds like you’ve been working hard at managing your weight and your diabetes — and succeeding, too! It’s not easy to make and sustain lifestyle changes. When you see your doctor in June, first focus on your A1C level, as that is usually what determines your treatment plan, at least initially. But even before your visit, knowing that your post-supper readings are on the high side, think about what you might try to bring them down. For example, can you make lunch your larger meal and eat a smaller dinner? Do you think you might be overdoing the carbohydrate a little (maybe aim to keep to 30–45 grams of carbohydrate)? Can you do you exercise after dinner to help lower your glucose? If you do end up starting on medicine, that’s OK! It just means that your body needs a little more help. But you’re already doing a lot for yourself with your healthier eating, exercise, and weight loss, so don’t lose sight of that. Having to go on medicine doesn’t mean you’ve failed at all. View it as just another tool to help you get your numbers in your target range — after all, isn’t that really your goal? Let us know how you make out.

    Posted by acampbell |
  44. Amy:

    If I do have to start taking medication for my diabetes, is there any chance of getting off it later or do I have to be on it from now on? I know many, many people take medication. However, as a former medical transcriptionist, I do know that people who lose large amounts of weight can rid themselves of diabetes (like those who may have gastric bypass). There is certainly nothing wrong with just eating healthy and exercising for one’s own well-being, I just would like to think I can manage this on my own. I guess the initial 3 months “grace” my doctor gave me was to give me a chance to make some changes and get educated on this whole thing. Sometimes I just want to forget everything, but as far as I know, I will have diabetes the rest of my life.

    Posted by Stephanie |
  45. Hi Stephanie,

    Yes, it’s possible that you could get off medicine if you needed to start on it. The key is improving your body’s insulin sensitivity so that it uses what insulin it’s making more efficiently. Healthy eating, reaching and staying at a healthy weight, and regular exercise are ways to improve insulin sensitivity, apart from medicine. However, it’s really not true that diabetes “goes away.” In fact, new research about gastric bypass “curing” diabetes is now being debunked. At this point, there isn’t a cure for diabetes. I don’t say this to discourage you, but rather, to help you think about diabetes as something that is manageable, as long as you have the right tools in place. And you should consider your “grace” period as being successful! Look at how far you’ve come. Continue to do what you’re doing. Try not to get discouraged if and when the time comes that you need medicine.

    Posted by acampbell |
  46. Hi Amy: I have written to you before. I was just wondering if there is a way to know if my hemoglobin A1C has gone down without having something to check it. I know when I see my doctor in June, he will do this and it will help him decide how to treat me. I have had a previous A1C of 7.5, but I have lost from 155 pounds now to 133 pounds, I usually do some exercise 6-7 days a week, and I am eating a diabetic diet. I can’t wait to see if any of this has affected my hemoglobin A1C. I plan to ask my doctor that if he wants to put me on medication, if he will consider taking me off it if I continue to lose weight and be active.

    Posted by Stephanie |
  47. Hi Stephanie,

    You could possibly gauge your A1C by using something called the estimated average glucose (eAG), but you’d likely need to do a lot of fingersticks to get an accurate estimation. The other option (if you really can’t wait until June!) is to purchase a home A1C kit at the pharmacy. You need to do a fingerstick and you get your results in just a few minutes. You don’t mention how often you’re checking your blood glucose, but you might consider, for maybe a couple of days each week, checking before each meal, at bedtime, and then 2–3 hours after a meal. If these readings are within target, chances are your A1C has gone down.

    Posted by acampbell |
  48. the article was very informative and it cleatred my doubts regarding the eventuality of medication,in spite of diet control and exercises.
    thanks alot

    Posted by n.k.somanath |
  49. Amy:

    I had my first 3-month followup with my doc today. My hemoglobin A1C went down from 7.5 to 6.7 this time and I have lost 20 pounds, I am 134 now. My doctor wasn’t even really interested in looking at my blood sugar readings, he was just mainly concerned with the A1C and since it was better and I had a good weight loss, he said I could continue as is and did not need medication at this time. I am thrilled, as that is what I wanted to hear from him. He also changed my antihypertensive from lisinopril HTZ to plain lisinopril, as he said my blood pressure was better. I think I am very fortunate to have a doc who is willing to work without medication or cut it back when he can.

    Posted by Stephanie |
  50. I had a mastectomy 3/18/2010. I noted later that bl tests just before surgery showed a ser glu of 130. It was fasting as I had fasted for the surgery. Though maybe I was on glucose for the operation?
    My husband is a doc, and said everyone’s bg goes up w/ the stress of surgery.
    A decade ago, my fasting gluc was in the high 70’s.

    Before the operation, I noted a fasting gl of 99. Another time pre registering at hospital [ also pretty stressful] it was 110!

    I got a home meter, and usually it is mid to hi 90’s, a cpl of times it has been 100-106 over the past cpl of months. Overall it is only going lower. I have lost 25 pounds since Jan 1, my diet is almost all veggie, fruit, whole grains, low fat[ sardines 1x/wk, 2 oz of chicken 2x/wk], and am committed to 30 min at least walk daily.
    But it seems it is going down very slowly. I’ve had a cpl of readings in the 80’s during the day, and one 88 fasting.

    My paternal gm was type 1, my father had late onset and heart disease in his 60’s. We ate and lived quite differently. So is it now a fact I am managing pre or diabetes? Or is htis an incident in time, a very stressful year [ 2 hospital events] that I can recovering from?

    Posted by susan |
  51. Hi Stephanie,

    That’s great news on all accounts! You’ve done a great job and yes, you’re indeed fortunate to have a physician who is working so closely with you to individualize your treatment (and give lifestyle measures a chance!).

    Posted by acampbell |
  52. Hi Susan,

    Glucose levels can certainly go up during times of stress (which includes having surgery!). Prediabetes is defined as a fasting blood glucose (done at the lab, not on your meter) between 100 and 125 on two separate occasions. Diabetes is diagnosed if the fasting blood glucose is 126 or higher on two separate occasions. Fasting means that you haven’t eaten or had anything to drink other than water for at least 8 hours. A hemoglobin A1C can also be used to diagnose both prediabetes and diabetes, too. My suggestion is to ask your physician to check you for prediabetes so that you’ll know for sure. In the meantime, keep up with the healthy lifestyle changes!

    Posted by acampbell |
  53. Hi Amy

    I have done GTT which was 129 & A1c 5.9, where fasting is bet 90-98 regularly……
    It is done excatly 2 months after first A1c which was 8.6,
    Now should i consider that am not diabetic & ignore first a1c ?

    Please help
    Akaash

    Posted by Akaas |
  54. Hi Akaas,

    I’m not a physician and am not able to diagnose, but it does appear that you don’t have diabetes. However, your two A1C levels are a little on the high side, which could indicate that you have prediabetes or are at risk for diabetes. It’s also important to consider other risk factors that you may have, such as a family history of diabetes, being overweight, not getting enough physical activity, having a history of gestational diabetes, and being from certain ethnic groups. I’d suggest that you talk with your physician about your own risk factors and steps that you can take to lower your risk.

    Posted by acampbell |
  55. Hello ….was diagnosed 5 years ago with a slight elevation of fasting glucose (80 to 90).Have lost weight and did exercise(not as much now but am active).Watch my diet and morning fasting is usually 86 to 90.Has only spiked on fasting if ate carbs too late at night.My last two A1C was 5.4 & 5.6.I monitor my glucose after each meal and really watch my diet.My doctor doesnt seem to be worried and said im doing well.If i continue to keep this remedy up could i one day become diabetic.I am going to lose more weight and i think this will help more.I really like your comments and think more doctors should send people to diabetic classes with a nutritionist when they are prediabetic so they can really understand how to learn to eat and how to keep blood sugar down.Love your sight….and your answers….Have a blessed day!….aj

    Posted by aj |
  56. Hi aj,

    Congratulations on all of your hard work and efforts — which seem to be paying off! It’s hard to predict whether you will develop diabetes in the future. Much of that will depend on how well you continue to eat healthfully, stay active, and regulate your weight. Other factors play a role, too, in terms of risk for diabetes, such as having a family history of diabetes, ethnicity, having a history of gestational diabetes, or giving birth to a large baby. Findings from the Diabetes Prevention Program have shown that a healthful diet, regular exercise, and changing habits can lower the risk of getting diabetes by 58%, so I’d say you have a very good chance of avoiding, or at least delaying getting diabetes. And I appreciate you supporting the role of nutritionists for prediabetes management. Thank you!

    Posted by acampbell |
  57. HI,
    I am quite baffled with my situation. I have been very lean my whole life and am a fitness instructor and avid bodybuilder( prefer not to compete publicly). I exercies 5- 6 days a week above the normal person my age as I lift very heavy and do 2 intense aerobic workouts per week and 4 very moderate. My HBA1C hovers at 5.9 and hasn’t been lower than 5.6 in 10 years. Doctors ignore this even though organ damage is ocurring at 4.7 (HBA1C). Diabetes is in my family but so is heart disease and heart issues have a strong relationship with HBA1C over 4.7. I eat an impeccable diet..remember bodybuilders diets are low in simple carbs and high in protein. In light of all this clean living my fasting blood glucose is showing regularly at 100 and sometimes in the 90’s. This change ocurred over 3 months time. My blood sugar even goes up at exercise many times and it is rarely lower after exercise. It just stays around 100 all day. This is extremely discouraging. How is it if I am in fact type 2 that exercise and diet are not controlling for insulin resistance ? Actually I question as to whether I am actually resistant or whether I have lost beta cell function which would be more type 1..only latent ?

    Posted by emfie |
  58. Great Column and feedback. At 62 after stroke, I had to go back in and re-tackle the whole mess and get back under management with controlled diet, exercise and carfeully checking everyhing.

    In your column it was self evident the confusion among the patients/your readers but also clear why this disease is so complicated.

    I am very angry about the lack of clear data out there about dawn effect, the sygmoli effect - emergency sugar add.

    WHen I started, I was on actos, metformin, starlix and my body a mess. Today, I have my monster dawn effect stripped back and controlling the emetrgency sugar add by watching the blood sugar during day and adding snacks to prevent this. I struggle to maintain sugar around 130 to 140, below this point my large body can draw down sugar to 69/70 no sweat.

    After cutting back all food, I was still getting sugar readings every night - 110 at 1:00 am; 150 at 3:00 am and 235 to 260 at 6:00 am. Reliably each and every day the numbers fell out like that. A year ago, I grabbed my BS metter and went walking. AFter 2 miles of effort, I finally got BS down to 140 or less. I was having to do that each and every day or my sugar got trapped at 180 plus.
    ACtos was added supposedly to help push this down.
    Humolog was added because my body takes 3 hours to get pills from hand to blood stream.

    It turns out that by my taking metformin - 500 mg at 10:00 pm and 12:00am; my blood sugar would now track what it was at midnight. 108 at midnight and I would have 103 at 5:00 am. The funny part is that as the metformin wears off the blood at 5:30 am, I can see my liver struggling to hike the sugar up for the dawn effect after being locked out after nighttime. It turns out that the 23 units of humolog at 5:00 am combined with taking my breakfast metformin early at 5:00 am and walking for 1 to 3 - 1/4 mile hikes will push liver back in cage so it cannot hammer blood too hard and keep blood sugar down at 100 to 140.

    The rest of day I wold be on metformin, glyburide pill in am and night, low glycemic diet with sufficient starch to keep glucose up. At night a single 10 unit charge of lantos is added and this helps to keep things rattling. You folks have not lived till you see large liver in 6ft 2 person - 300 lbs in full flight doing a emergency sugar add when bs gets to where you run it down to trip point. I have sat pulling test strips one after another and see blood start at 220, 250, 280, 311 and then HI and then watch as it dilutes through body back to 230 and stops there.

    I have to take umbridge/brickbat over comments and attempt to indicate why type 2 takes insulin and its impact.

    Today, I am off actos, have diet worked out and watch numbers very closely. I have all the excess water out of my system and my live has stopped sugaring me like a marachino cherry.

    No good comes from failing to instruct in factors generating and controlling sugar, nor over simplifications about dawn effect and sygmoli effect and propoer training of patience. For some these effects are a minor inconvenience - for this old dog they are catastrophic.

    I also point out something from Salk Institute:

    Scientists discovered a genetic “fasting switch,” called CRTC2, that flips on glucose production in the liver – the same switch that remains permanently on in patients with Type II diabetes. A collaborative study among Salk researchers revealed that a common diabetes drug (Metformin) works to inactivate CRTC2 and shut down glucose production. Having identified a molecular target for this drug, new, more active drugs will be easier to develop.

    In healthy people, a “fasting switch” only flips on glucose production when blood glucose levels run low during fasting. “The existence of a second cellular signaling cascade—like an alternate route from A to B—that can modulate glucose production, presents the potential to identify new classes of drugs that might help to lower blood sugar by disrupting this alternative pathway,” says Montminy.

    Posted by jim snell |
  59. Hi emfie,

    I wonder if perhaps you may have Latent Autoimmune Diabetes of Adulthood (LADA)? Have you discussed this possibility with your physician? Please realize that I cannot diagnose you in any way, but it’s something that you and your physician might consider. LADA is basically a slow-onset Type 1 diabetes whereby beta cells in the pancreas gradually stop working. People with LADA tend to be on the slender side. Your doctor could check you for pancreatic antibodies; if you test positive, it could indicate Type 1 diabetes. Again, I am not saying that you have diabetes at all, but given your blood glucose readings (which are really not that high), it’s just something to pursue with your physician.

    Posted by acampbell |
  60. My doc put me on the type 2 list two weeks ago. I bought a tester and the fasting AM # is about 125. I have gone on a low carb diet and begun a 2 mile walk every day. I was prescribed a medication for this but am trying to get things under control with diet and exercise but, no meds. Is this a viable goal? If I continue the diet how long until I can expect a change (or no change) in order to determine if the meds are truly the answer. The meds may be necessary but sometimes I am leery of a one test diagnosis and a quick fix prescription.

    Posted by Charlie |
  61. Hi Charlie,

    It’s certainly possible that you can manage your diabetes with diet and exercise, at least for a while. However, it’s fairly standard practice now for providers to recommend that those newly diagnosed with Type 2 diabetes start on metformin, a type of diabetes medicine, along with making lifestyle changes. Hopefully you’ve had a discussion with your provider about this and if not, I’d suggest you do so. If he or she is agreeable to you holding off on taking your medicine, set a time frame, say, 6 to 8 weeks, to determine whether lifestyle alone is successful. Also, another factor to consider is your A1C. If it’s above 7 or 7.5, it’s probably a good idea to start taking your medicine.

    Posted by acampbell |
  62. Hi acampbell

    I’m 32 years old male, overwighted, and lazy.
    recently I’ve tested my FBS and it was 117 & 128 in two consactive days in different labs.
    does this readings means I’m deiabetic or I’m prediabetic.
    is it still possible to bring my BS levels to normal readings by wightloss and exercising without Meds.

    thanks a lot

    Posted by Konrad |
  63. Hi Konrad,

    One way to diagnose diabetes is by checking a fasting blood glucose at a lab. If the reading is 126 or higher at two separate times, diabetes is diagnosed. The fact that you had a reading of 117 and then a reading of 126 but at a different lab makes it a little harder to say that you have diabetes; you should have the test done at the same lab. You should also ask your physician about your diagnosis. He or she may tell you that you have diabetes or even prediabetes. Losing some weight, making healthier food choices, and becoming more physically active is important whether you have prediabetes or diabetes, so I’d advise you to get started with these lifestyle changes. One other thing to keep in mind: It’s now become fairly standard practice to start people newly diagnosed with Type 2 diabetes on metformin, so you really should talk to your physician about what is best for you to do at this point.

    Posted by acampbell |
  64. thanks amy for the reply

    Sure I will start lifestyle changes immediatly and I will check with my doctor about this lab readings.
    but regarding the diet what is the maximum allowed amount of caloories one with diabetes should take daily and how many of carbohydrates should one takes ?
    I’m unaware of the callories and carbs calculations, I’ll appreciate if you have any good refrence for them

    Best regards

    Posted by Konrad |
  65. Hi Konrad,

    The number of calories and amount of carbohydrate that a person needs really varies. It’s based on your age, gender and activity level, as well as your blood glucose readings and also your food preferences. Would you be willing to meet with a dietitian? He or she could help you develop your own meal plan that is based on your lifestyle and calorie needs. You also might take a look at Diabetes Self-Management Meals & Menus for 1 or 2, and the American Diabetes Association has several meal planning books that may be helpful. In the meantime, purchase a carbohydrate counting or food counts book and try aiming for about 60 grams of carboydrate per meal each day. Try to keep protein portions (meat, poultry, fish) to between 4 and 6 ounces per meal, and go easy on added fats, like margarine, oil, salad dressing, etc. This is to get you started until you see a dietitian.

    Posted by acampbell |
  66. I am losing weight and my sugar level avarages 125should I do some consultation??

    Posted by silva |
  67. Hi silva,

    If you have concerns about your weight and/or your blood glucose, then I would say that you should speak with your physician. Unintentional weight loss (losing weight without trying) is always something to check into. Your blood glucose of 125 isn’t necessarily high; it depends on when you’re checking, for example. But the fact that you’re checking your blood glucose in the first place has me wondering if you believe that you’re at risk for developing diabetes in the first place. So, to be on the safe side, I agree that a visit to your doctor is a good idea.

    Posted by acampbell |
  68. I just want to say a big Thank You for publishing this article about Diabetes-I Have Type-2 Diabetes and sometimes it is a big struggle to deal with it because other people are so inconsiderate!!! I did not plan to get this Disease-I centainly would not wish it on my worst enemy-If I had one wish granted it would be to go back to those great years where I could eat what I wanted when I wanted it with everybody else!!!!

    Posted by Angie Owsley |
  69. Another question. I’ve got a friend who is trying to get his weight to his BMI by eating correctly. He’s not exercising very intensly yet but is working on it. His goal, like me, was to get away from all medications that he can. That said, he quit taking his oral medications and won’t check his glucose level while he’s doing this because of the side effects. I highly discouraged this and recommended he consider Insulin which has much less side effects and mimicks the body more closely. (This is my plan if I progress to Diabetes stage) My question is: If he uses insulin but continues to exercise and eat correctly, loses weight to his BMI, will his body require the insulin because it gets used to having it? OR will his amount of insulin reduce if his body begins get in shape…so to speak, hopefully to he requires none?

    Posted by Don |
  70. Hi Don,

    Good questions! First, you might encourage your friend to go back to checking his blood glucose in order to determine how well his eating and activity program is working for him. But to answer your question: If your friend were to start taking insulin but at the same time lose weight and be active regularly, it’s possible that he could stop taking insulin or reduce his dose considerably. It’s hard to say if he really could stop taking it altogether. It would depend on the duration of his diabetes and how much insulin his own body is continuing to make. Remember that, with Type 2 diabetes, two things happen: The body doesn’t use insulin as well as it used to (insulin resistance) and the body also doesn’t make as much insulin as it used to. The longer a person has had diabetes, the smaller the chances of getting off medicine or insulin. Physical activity and weight loss can reduce the insulin resistance but if the pancreas can no longer produce enough insulin, your friend may still need to take insulin by injection. That’s why resuming blood glucose checks is important in addition to getting his A1C measured.

    Posted by acampbell |
  71. hi iam 32 year old recenty have fbs=100, &ppbs=190 what to can it be cantrolled with exe&chage in life style

    Posted by rashmi wakpanjar |
  72. Hi rashmi,

    Yes, you can definitely control your blood glucose (prediabetes) with a healthy eating plan and physical activity. If you are overweight, losing 5% to 10% of your body weight can help. Meeting with a dietitian may be useful to teach you about portion control and healthy foods. Also, if you can, aim to do about 30 minutes of physical activity most days of the week. Start with walking if you’re not usually active and it’s OK to start out slow and gradually increase. You have a very good chance of preventing diabetes at this time.

    Posted by acampbell |
  73. Hi, i am a 56 year old woman with quite high blood pressure. I am just over the border line for being overweight.
    I went to have my eyes tested as my vision was getting worse, some days ok, some days really bad.
    Optician noticed my eyes where going from minus reading to plus reading which is very unusual for my age. Also i had blurred vision on and of. So he told me to find out the last time I was tested for diabetes. The surgery told me it was in Feb 2011 and the reading was good at 5.2
    Now some one told me that a reading of 5.2 is good if you where diagnosed with diabetes but a normal reading should be 4 or under for people not diagnosed with diabetes.
    Is that right. I haven’t been back to option yet as that is next week, but in the mean time I worry about it.

    Posted by henny |
  74. Hi henny,

    According to the American Diabetes Association’s Standards of Medical Care, the A1C (which is the number that you’re referring to) can be used to diagnose both diabetes and prediabetes (meaning, high risk for developing diabetes in the future). An A1C of 6.5% or higher is considered diabetes. An A1C between 5.7 and 6.4% is considered prediabetes. So, your goal is to keep your A1C below 5.7%, which you are doing. You should keep tabs on your A1C if you have risk factors for developing diabetes, such as being overweight, having a family history of Type 2 diabetes, high blood pressure, and not being physically active. Since it sounds like you may have a few risk factors already, talk to your doctor about what you can do to lower your risk.

    Posted by acampbell |
  75. Hi!
    Every body. my experience was totally different for diabetics.
    During routine every year body check up, i was found to be diabetics. my fasting blood sugar = 206 and pp sugar is 367. i was scared as soon as i received report. i took half day and went to laboratory to check my pp. once again it shows 311 but lower than first result i.e. from 367 to 311. down by 56 units just in seven days. i decided i must check again after 3 days with my fasting and pp sugar. i checked it once again. surprising i found by fasting is 165 and pp is 175. how the blood sugar fluctuates so much in just 3 days. my urine after pp is dropped from +++ to 0.25. My hemoglobin A1C shows 10.3 which is very high. i did not check once again. my doctor advised me to start Metformin 500 SR. before starting this medicine, i decided to wait for 1 month by doing exercise and healthy diet. i am also physically handicapped. i started walking at least 35 minutes a day. i feel sometimes weakness on evening.is it my glucose is dropping.

    Posted by Biren |
  76. Amy:

    Your blog actually is very balanced and openminded and I mssed how well you covered this.

    In my mind there are three issues in this having to due with:

    medical tuning and assistance to an aging complex organ system to ensure constant overprodduction of glucose is reigned in.

    Haerty exercise is absolutely crucial in getting stored glucose in skeletal muscle cells exhausted out and burned off. Muscle cells only work one way blood stream to cell and only exercie can wipe out.

    Insulin is only used by body to store excess glucose in liver, fat cells and skeletal muscle cells. If those fill up, body BG regulation is impossible - keep adding insulin but pray there is enough room at all times to absorb glucose.

    On the front end, body grabs all caloroies all the timne and expects body to dump.

    If exercise and energy burn is less than input energy. the crap backs un in body and voila - fat and type 2 diabetes.

    The human body and especially hunter gatherer gene sets/digestion systems were designed and optimized 10,000 years ago to bang along the bottom of food supply/calorie supply and not control along the top of daily excess glucose supply and generation and in fact periods of starvation and insufficient food/calories was required to keep body balance of BG glucose under control.

    Today energy/calorie input management and energy burn MUST be carefully balanced so as not to overload the body.

    Praying for the unified field thinking there is one problem and its genes and autoimmune causing this problem will cause one to rot ones body out waiting for that “cure”.

    Posted by jim snell |
  77. Hi Biren,

    I’m assuming that you’re checking your blood glucose with a meter. It’s great that your blood glucose is coming down, and it’s likely that your walking is helping, along with any changes you’ve made to your eating. Your A1C is quite high, however, so it’s likely that you will need to start taking metformin at some point. As far as the weakness that you have at night, it really could be due to a number of things. You should check your blood glucose with your meter. The weakness may also be due to your walking. If it continues, please let your doctor know.

    Posted by acampbell |
  78. There are exceptions to every rule. I was admitted to intensive care on April 12th with blood sugar of 1839, in sepsis, body temperature of 92, in a coma. I am 54 years old. I was given a 20% chance of survival. One week later, diagnosed with adult onset Type 1 diabetes, I walked out on my own power. At the time, the doctors told me that there was a chance that my pancreas could jump start and begin producing its own insulin. Ten days ago, it apparently did just that. I am no longer on insulin or medication of any kind for the diabetes. Indeed, I’m having a little trouble keeping my blood sugar up. While I feel certain that my pancreas has healed some and is producing at least a certain amount of insulin, I believe that diet and exercise are accounting for the rest. Perhaps I’m wrong. All I know is that two weeks ago, I was taking two 40 unit shots of insulin a day, and now I’m taking none and my blood sugar never rises above 120.

    Posted by Tony Hays |
  79. In two days i’m going to get myself checked out whether i have diabetes or not. However atm, i’m feeling a little bit dizzy, my legs and arms very easily go numb (not completely though), and i urinate out whatever i drank after 30minutes.

    For several months i’ve been very tired all the time and in the last month my desire for sugar in general has decreased massively. Also, in the past few days my kidneys hurt a a little for a few minutes before i went to bed.

    I woke up the worst this afternoon but now in the evening i feel better. I’ve also checked out my vision about a week ago or so to see whether i had a problem with them, since they had been hurting from time to time for a very short while. It turned out i have astigmatism. They are a bit blurry at the moment.

    Should i wait untill monday morning to get myself checked out or do i need to do it right now,(then i have to visit the emergency because doctors only have open hours on weekdays).

    And i’ve also been training 5 times a week this last month, taking creatine about 2-3 times a week, and protein shakes (gainer). Could this have anything to do with it? I started smoking last month aswell.

    Hopefully i can get an answer, i’m really worried(By the way, i’m 17 years old)!

    Posted by Daniel |
  80. Hi Daniel,

    Sorry I didn’t respond to you sooner, but I’m hoping you were able to see a doctor. Not being a doctor, I can’t say if you have diabetes, but you should definitely get your symptoms checked out. Let your doctor know that you’ve been taking creatine and supplemental protein (and work on stopping smoking, by the way!). It’s probably unlikely that the supplements are causing your symptoms unless you’re taking very large doses, so in the meantime, only take what’s recommended on the container. Let us know how you make out.

    Posted by acampbell |
  81. @ Amy, No offense but you seem adamant that no matter what a person with diabetes does, nothing will change the fact that the disease exist. As a diabetic I know how important a role genetics play in the development of diabetes but a person’s environment (lifestyle)plays a bigger role. There are a number of research being conducted which shows that a person with diabetes has other healthier options namely a proper diet and exercise than be stuck on pharmaceuticals. The body is an extremely marvelous thing, that knows what it needs and knows how to heel itself. A balanced diet and physical activity helps the body back to homeostasis and in essence heal itself where medications may not be required, which is what so many doctors and researchers out there are proving every day.

    Posted by sammyb28 |
  82. Hi sammyb28,

    Thanks for your response, and no offense is taken. Being a dietitian, I’m a big proponent of lifestyle measures for both the prevention and treatment of diabetes. I agree that many people can manage their (Type 2) diabetes with a healthy eating plan and regular physical activity. The point I was trying to make is this: most people with Type 2 diabetes do end up taking medicine for their diabetes, and if one needs to start taking a pill, or add another pill, or start on insulin, it’s important not to feel guilty about it or feel like a failure. It can be hard to control blood glucose levels via food and activity all the time. Sometimes it’s possible, but sometimes it isn’t. It’s also a discussion that everyone with diabetes should have with their physician and/or health-care team. And remember that the best gauge of how your diabetes is doing is your A1C level. This number should be the main determinant for your diabetes treatment plan.

    Posted by acampbell |
  83. Ther is a major failure on the part of the “industry” treating type 2 diabetes and all the misleading information and wrong headed advice.

    There are three planks in this - medical issues causing excessive glucose relase from liver, hormone fracas from gut and endo organs; carb control and exercise.

    If the first issue medical problems broken; the final two carb control and exercise are hard pressed to make up difference to overcome the medical problems.

    The key misleading information is the one-half butt story on how Insulin works. The story peddled is partial and suggests that only shove insulin at problem, ie - BG too high - just shove insulin at it.

    Studies under the ADA banner clearly show that the issue of insulin resistance is key and that the fat cells, skeletal muscle cells and liver all have capability to use/ignore the insulin in the blood stream based upon the level of glucose stored in these cellular elements.

    Reducse the locsl stores with sufficient extra exercise, control carbs glucose generation with diet and use medicine to stop leaky liver glucose and unwarranted glucose release will enable stop over filling the fat cells, liver and skeletal muscle cells and voila, the storage based regulation system of human body returns back to working when there is always room to store more glucose. Then the insulin works and the rot stops.

    The present stupidity of just shove more insulin and apply avandia/actos at the problem is a war within the human body with the liver, fat cells and skeletal muscle cells resisting being made into marachino cherries and the medical official solutions crowd believe that just shove more in there and add ever increasing levels of insulin.

    This war leaves no live prisoners and guarantees body rot throughout the body.

    The ADA and other have the data and reports. For Christ sakes read the bloody stuff and drop the fanatical adherence tp orthodoxy that is causing an explosion in diabetes rates around the world by 200 and 300 per cent in this day of 24/7 farm raised grains, rice, corn, sugars and the magic of science. The human body was optimized 10000 years ago to protect and run against poor food, chronic shortages and starvation. By passing the extra carbs/glucose out once body fill of glucose not part of that story. Nature, the Gods et all left that to the human to implement.

    Posted by jim snell |
  84. Yesterday after a routine blood check up the fasting blood sugar came as 108mg/dl for the first time. Is it early diabetes? If so, what will be the dietary changes/exercise pattern?

    Posted by s.ghosal |
  85. Hi s.ghosal,

    It’s important that you having another fasting blood sugar checked. These kinds of tests should be repeated on a separate occasion before a diagnosis of prediabetes or diabetes is made. If your second blood glucose result comes back above 100, then your doctor may tell you that you have prediabetes (or impaired fasting glucose). The good news is that you can prevent this from evolving into Type 2 diabetes by making some lifestyle changes. For example, studies show that losing 5–10% of your body weight can lower your risk of diabetes by almost 60%. You might also think about changing your food choices to more vegetables, whole grains, leaner protein foods (chicken, fish, tofu), nonfat or low-fat milk and yogurt, and vegetable oils. Aim to fill about half of your plate with vegetables. Include more nuts in your diet. Cut out sugary drinks, like juice and soda. Also, be more active: Aim to do some type of physical activity most days of the week. If you feel like you need more guidance, make an appointment with a dietitian at your local hospital or doctor’s office.

    Posted by acampbell |
  86. I have added my comments before. I believe we in west are over focused on Insulin efficiency to the exclusion of how the body really works and the focus needs to be on liver leakage, glucose saturation and insulin resistance.

    Trying to find ever more solutions to shove more glucose into cells without solving insulin resistance and glucose saturation is whistling pass the graveyard. I found a Eastern research article that maintains T2 is a liver disease - for which all my 26 years nearly rotting out and now 4 years of numbers and cure improvement progression prove out.

    That web site is:

    http://integrativetherapyresearch.org/

    Posted by jim snell |
  87. I aslo meant to add that - Dieting/carbs control and exercise and their rersults ties in better with this theory and why low glycemic diets and exercise follow directly from this thinking.

    Posted by jim snell |
  88. Hello,
    I was wanting to know can a morbidly obese person that has type 2 start eating better exercising and cure their diabetes or make it go into recession if they start controlling and losing the weight. I am 200-215 lbs over weight, I am wanting to lose weight and now since my numbers are creeping up I defiantly am going to try harder than ever to lose weight I have been drinking lots of water to get the numbers down and I really don’t want to have to take medicine, the only problem I have found was is that when I try to diet right and exercise my blood sugars go into the 60s so what can I do? I dont have insurance so I cant check my blood sugar as much as I want.

    Posted by nikki |
  89. Hi nikki,

    Right now, there is no cure for Type 2 diabetes. But the good news is that studies have shown that healthy eating, physical activity, and losing 5–7% of body weight can definitely help one manage blood glucose. It’s a little hard to say if losing weight will be enough for you to manage your blood glucose, because it depends on many factors, such as how long you’ve had diabetes and what your A1C level is. Nevertheless, I think it’s great that you want to get on track with better eating and weight loss, so you should definitely move forward with this. Since you’re not on diabetes medicine right now, the risk of your blood glucose going too low is pretty slim. Don’t let this discourage you from exercising. If it turns out that your blood glucose really is going too low, your doctor or a dietitian can help you better manage this.

    Posted by acampbell |
  90. Amy:

    I believe that the latest thinking and by your comments is most suggestive that energy balance in human body is key to solving the t2 mess.

    Better diet and I read that as careful carbs control help limit the energy input to body.

    Hearty exercise each day is crucial to keep calories burned off from the skeletal cells.
    Body insulin is only used to cause transfer and storage of glucose from blood stream to temporary glucose storage of muscle cells. As long as their is always room, BG stays in regulation. Exercise burns off glucose of skeletal muscle cells storage always keeping extra room to continue blood stream regulation. Insulin does not cause glucose consumption, exercise and process burn do.

    ANother factor ignored and not really properly addressed is the body setpoint control of the liver as source of steady low stream glucose, the pancreas as control issuing basil pulses and the skeletal muscle cells as a dump location that insulin controls the absorption of extra glucose and keeps blood stream glucose at its limit. That is a proper negative feedback servo system.
    Babling on about 2 hormones as control aint it.

    For some reason, as one ages, the liver leaks more glucose, the pancrease ages and slows regulating all leading to the skeletal muscle cells getting topped off. Drugs are required at this point to slow liver down and some insulin added to make up pancreas loss due to age/disease/genetics.

    This is why at pre-diabetes and early stages, carbs control and extra hearty exercise help keep world under control since liver leakage thowback is small.

    As years go by, liver leakage goes up and pancrease aging, skeletal muscle glucose temporary storgae at risk of saturation leading to severe insulin resistance. At this point;
    drugs, carbs control and heraty exercise are all required to get mess back under control.

    Thank you for your execellent blogs on nutrition, diets and health.

    Posted by jim snell |
  91. Amy:

    I realize that 1200 calorie diets are not for everyone but:

    Its critical to get glucose pressure on body arrested and the glucose saturation/filling up of skeletal muscle cells temporary glucose stores causing massive IR stopped.

    I truly suspect once the issues are stopped, one can up diet again to stop any weight loss.

    Stuffing more insulin/actos by itself is in my opinion a lost cause causing body rot out. Dropping average glucose sub 150 and A1C sub 7.0 is critical to stopping rot. If our veins and arteries were made of neoprene rubber, this probably would be less an issue.

    In old days of cars, natural rubber was used on gas lines of the cars and that rubbere would routinely go soft and rubbery. You might look into the work of Dr. Roy Taylor at the University of Newcastle on Tyne using mri spectography and extreme 600 calorie diets.

    While many attribute the results of bariatric bypass as a hormone fix. My suspicion is that a massive drop in glucose/calorie input has more to do with this causing a removal of glucose saturation and resetting the bodies glucose control system.

    Posted by jim snell |
  92. I was recently diagnosed with high blood sugar I have seen a nutrionist and walk on my treadmill for 30 min a day I have also lost 34 lbs and watch what I eat my first A1C was done the 1st of February and I had another done the end of March even with the weight loss my A1C is 6.5 is a month long enough to see if someone is diabetic I am overweight and 54 years old should I speak to my Dr about giving me more time? to see if I can get my number down? If I don’t have to take meds I really don’t want to.

    Posted by Pat |
  93. This column is almost six years old and still drawing comments! I think we have learned since then that Type 2 is not always progressive. If you stay on a starchy diet, or if you stop exercising, you will progress for sure. But many (not all) people who move to a vegetable- and protein-based diet, cut way, way down on starches and sugar, and exercise more find that their Type 2 actually gets better.

    Unfortunately, the ADA long recommended starchy diets, so naturally everyone was getting worse. As people age, they tend to move less, which also causes Type 2 to progress. But these factors can be changed! I’ve reviewed dozens of cases of people with Type 2 getting completely off medicines on some version of a Mediterranean diet, like Dr. Hyman’s Blood Sugar Solution or Dr. Stepich’s 30-Day Diabetes Cure. They’re not “cured,” but their numbers become normal.

    The more advanced you are in diabetes, the longer you’ve had it, the harder it is for the body to recover. But it seems like most people can stop their progression. This chronic progressive label was applied by the same experts whose diet advice was making sure people progressed. In my opinion, It’s not universally true.

    Posted by David Spero RN |
  94. Hi Pat,

    Congratulations on your weight loss and your efforts at eating well and being more active. Those are no small feats! The issue for you is that even with an A1C of 6.5%, you’re considered to have diabetes (although this is usually confirmed with a repeat test on a different day). The standard protocol for anyone diagnosed with Type 2 diabetes is to start on metformin, a type of diabetes pill, right away. Metformin is even being prescribed for people who have prediabetes or who are at risk for diabetes. This is a very safe medication with minimal side effects (there is possibly some gastrointestinal distress but that typically goes away shortly after starting). However, your doctor may feel differently, given how well you’re doing, so you should have a discussion with him or her sooner rather than later regarding the best plan of treatment for you.

    Posted by acampbell |
  95. David Spero has said many good things here especially the part about stopping diabetes.

    Dr. Roy Taylor of the Unibersity of Newcastle MRI center who has been doing work in this area on starvation diets reported similar ideas whereby they got the rot stopped.

    He indicated that after they had sent out their press reports; that they got calls and emails from all over England from folks who had successfully stopped the rot. i hesitate using word - cured as I suspect in my opinion that after one stops the rot, one needs to be sure one is under strict carbs control and exercise (energy balance) to ensure preventing overloading the glucose to the ole hunter gatherer digestion system that is super efficient about grabbing every spare calorie and making glucose and shooting into the blood system. The body is still operating as if it was back in the times of low garde fuel coupled with pooravailability needing excess effort to rustle up.

    on the issue of progression, data is not clear but in my case my liver got worse about shoving in additional glucose in an uncontrolled fashion that once it was corralled using control and metformin techniques, the carbs control and exercise are supremely necessary with consistent discipline and application.

    Best wishes to all.

    Posted by jim snell |
  96. Hi I have a question my mom checked her blood sugar with an expired strip. Her reading was 125 on Sunday and she checked it again today and it was 133 is she diabetic?

    Posted by diz |
  97. OK, it seems that almost everything has been covered already, but I am still a bit puzzled by my own experiences. If I might just explain:

    After a long winter of absolutely no exercise, regular and fairly copious quantities of beer, and a generally not very well-controlled diet, I found that I had a fasting BG of about 230. I was shocked.

    After that I started to eat more carefully and started to go out for vigorous walks, and within three weeks I got an FBG reading of around 130 or so under similar conditions the 230 reading.

    Now, three more weeks on, I get readings of 130 or 140 after a morning walk. I have been on Metformin for the past two weeks, but people seem to think it takes longer than that to kick in.

    I also have morning syndrome, though, with readings of 200+ after eating nothing all evening and night. It seems to come down as the day progresses.

    Questions: Is it possible to ‘rate’ my level diabetes from these facts? And why do I experience no symptoms whatever? No thirst, no hunger, no frequent bathroom visits, no weight loss. I am actually struggling to lose weight! How come? I am not fat - just a bit thick in the middle, but I am hoping to lose that if possible. The point here, though, is that if I have diabetes I am supposed to see the weight falling off as one of the symptoms. Why do I have no symptoms?

    Actually, I do get one symptom, which is fuzzy eyesight, especially in the mornings.

    Posted by Brian |
  98. Hi diz,

    I’m assuming that your mother has already been diagnosed with diabetes, given that she is checking her blood glucose…? Expired strips can provide inaccurate readings, so she needs to get a batch of new strips. However, keep in mind that even people with diabetes have blood glucose readings that are within the “normal” range.

    Posted by acampbell |
  99. Hi Brian,

    You may not be having any symptoms (other than the blurry eyesight, which can be symptom of high blood glucose) because your blood glucose levels are likely not consistently high all day long. Also, some symptoms, like weight loss and thirst, don’t appear until glucose levels get very high (like in the 300–400 range). My advice is not to rely on getting symptoms in order to lose weight. Your walking will help (you’ll need to aim to walk every day for at least 30 minutes) and you should also include some strength training exercises, too, such as resistance bands or weights. Don’t overlook your food intake, as that’s the other half of the equation for weight loss. Finally, if you’re seeing high glucose readings in the morning, your liver is likely kicking out excess glucose overnight, which means that you probably need a higher dose of your metformin, so let your doctor know if these high readings continue.

    Posted by acampbell |
  100. consult medscape for info on diabetes

    Posted by olawale femi |
  101. I have just been diagnosed as diabetic. My blood sugar- fasting-120 and PP208. I wish to control through proper diet and excercise. Please suggest remdial measures.

    Posted by R.M.KARPATE |
  102. Hi R.M.,

    My main piece of advice for you is to ask your doctor for a referral to a dietitian to learn about meal planning and to develop a treatment plan that’s tailored to you. You may benefit from losing some weight, for example, so you and a dietitian can decide together on the best plan to try. You should also focus on increasing your level of physical activity, aiming to do at least 30 minutes of activity each day. There may be diabetes education classes in your community, too, so explore those options (often, calling your local hospital can be helpful). It can be hard to do this on your own, at least initially, and there is no one approach that is right for everyone.

    Posted by acampbell |
  103. Amy:

    What really drives me nuts is the limited undecriptive titles that hug topics.

    i.e. Treating waht type of disbetes with diet and exercise.?

    From my experience the issues withe type 2 diabetes is that the probelms with type 2 is the following issues:

    Glucose overload due to diet consumption, liver glucose overrelease result in skeletal muscle saturation that in facts stops/slows glucose regulation in the human body.

    Regulation on a human body is a storage fracas that as long as skeletal miuscle storage space remains the body through insulin release can keep numbers in range.

    In addition the excess glucose release by liver and diet intake and glucose storage saturation leand to tired pancreas that slows insulin release and/or stops it, making matters worse.

    For type 2 it is critical to:

    - pull body back to energy balance by adding metformin to slow liver glucose release, adjust diet back possibly temporarily so that intake is not constantly overwhelming burn/consumption in body.

    - increasing hearty exercise is also critical to help get levels of glucose storage in skeletal muscle cells hauled back so glucose does not back up in blood system.

    - yes insulin may be needed to assist poor/worn out/stalled insulin generation of a type 2 pancreas.

    - just adding insulin plus actos alone will not get you there to energy balance. Been there done that.

    - cures that focus on dropping glucose levels alone will not cut it and only result in rotting out body. Simply forcing full skeletal muscle cells to absorb more glucose when topped off simply not effective.

    Posted by jim snell |
  104. I’ve been a diabetic for over 20 years. I aquired this disease probably different from the “normal” circumstances. I aquired diabetes as result of an domestic volence incident. The extreme injuries resulted in removing two thirds of my pancreas and all of my spline. I’m blessed to be alive!(that’s a story all by itself)
    My health has been basically well, with the help of eating right,taking my glucose, and mainly exercising. My question is, what is the aquired amount of carbs should I eat prior and after exercise? What does it depend on? I try to stay well informed about this disease.

    Posted by Charliette |
  105. Hi Charliette,

    I’m sorry to hear about your circumstance but glad to hear that you are doing well. It’s a little hard to answer your question without knowing more details. However, I’m making an assumption that you don’t take medication for your diabetes. If that’s the case, eating before and after you exercise may not be necessary (unless you are an endurance athlete!). The main reason that people with diabetes need to eat before working out is to avoid low blood glucose, and that’s generally only a concern if someone takes insulin or certain types of diabetes pills, like sulfonylureas. Checking your blood glucose before and after you exercise will tell you how exercise affects you. But for more specific answers to your questions, consider meeting with a diabetes educator.

    Posted by acampbell |
  106. Hi -

    Thank you for the informative blog post and excellent on-going comment feed! I was just diagnosed with Type 2 Diabetes. I don’t know anyone with diabetes, so this blog is a lifeline! My doctor prescribed a glucometer and is allowing me 2 weeks to try to control my glucose through diet. I am thin and do not need to lose weight, and I am very confused as to how to adjust my diet for maximum results. Except for soft drinks, which I have stopped cold-turkey, I do not crave sweets, and I eat fairly healthily already — salads and well-balanced meals — except for the occasional hot dog, fast food meal, or scoop of ice cream once or twice a week. I know I need to exercise, and I plan to start walking immediately. Will excercise offset the soft drinks enough or does it look like I’m going to be facing medication anyway? I am a 53-year-old woman and would like to avoid medication if at all possible.

    Posted by Joyce |
  107. Hi Joyce,

    I’m glad this site has been helpful for you. You’ll certainly learn a lot from our readers. Out of curiosity, is there a chance that you might have Type 1 diabetes? At any rate, it’s wise to start walking, as you mentioned, building up gradually to at least 30 minutes each day. While you don’t need to lose weight, it’s still important to control your carbohydrate intake. Cutting back slightly on your carbs and increasing your protein intake (from healthy sources like seafood and poultry, for example) may be helpful. You may find it helpful to meet with a dietitian to learn how much carbohydrate to aim for at your meals and snacks. Also, it’s understandable that you don’t want to start on medication. However, it’s standard practice now for people with newly diagnosed Type 2 diabetes to start pretty much right away on metformin. In many cases, medication is necessary to help control diabetes.

    Posted by acampbell |
  108. Actually, I DON’T know if it is Type 1 vs Type 2. I just assumed that since my glucose apparently was in the “normal range” until I was 53, that it was automatically Type 2. What kind of tests should I ask for to determine if it’s Type 1?

    My glucometer and I have not yet had a meeting of the minds–I’ve tried to test several times, diligently following all the instructions, but keep getting machine errors. I’m going to try testing again tomorrow morning–wish me luck! I am in a rural area, do you think the local ER or fire department personnel or a pharmacy could help me if I continue to have difficulties with my machine?

    I have started walking (starting at 20 minutes/day, aiming for 45), am drinking only water and one V8 juice per day, and am closely watching carbs, but I fear I’ve also cut my overall calorie intake. Since adjusting my habits for only a few days now, I do feel better–less tired, more energy–and my waist size has decreased. How important is the BALANCE between carbs and protein?

    Posted by Joyce |
  109. Hi Joyce,

    It certainly may be Type 2 diabetes. I asked because you mentioned that you are thin. Often, though, when Type 1 diabetes is diagnosed, blood glucose levels are very high and the person often reports symptoms such as weight loss, extreme thirst, and frequent urination. Antibody tests can be done to determine the type of diabetes, as well. As far as your meter goes, there are a few options: You can call the toll-free number on your meter and a customer service rep can walk you through it or troubleshoot for you; you can meet with a diabetes educator (usually a nurse or dietitian) at your local hospital; or you can bring your meter to a pharmacy and see if the pharmacist can help you. In terms of your eating plan, you do need to aim for a balance between carbohydrate, protein, and fat. I assume you don’t want to lose any more weight, so again, I’d encourage you to meet with a dietitian for more specific guidance.

    Posted by acampbell |
  110. Thank you for you insights and advice, Amy. I may be getting a handle on the glucometer. I was able to successfully test twice today. Pre-breakfast fasting was 250; 1 hour after lunch was 278. I am discouraged. The doctor’s lab test was 294. It doesn’t seem to me like the exercise and eating plan adjustments are making much of a difference, but maybe I’m being impatient. Don’t worry, I’ll stick with the plan. I’m currently walking after breakfast. Is the timing of the exercise relevant?

    Posted by Joyce |
  111. Hi Joyce,

    Your glucose readings are running on the high side. But continue to watch your carbs (don’t cut them out, though) and walk. Walking after breakfast (or any meal) is fine. Don’t get discouraged if your doctor prescribes medication for you, though.

    Posted by acampbell |
  112. hi, yhis is kapil from india.plz guide i m in big problem actually my wife who is 34 years old suffered from Dengue in the month of oct.11. when the doctor checked her glucose it was high due to give too much juices. now since then her glucose label comes border line. her hba1c was 6.5. 9 months ago but 2day her hba1c is 7. what shud i do and fastin is 120.what shud i do? i m tensed actually i have to plan for the family i have only 1 daughter we hv to plan for other. does it will effect in pregnancy. she is little bit healthy may she b cured wid exercise and change her life style. does she start medicine ? plz suggest..

    Posted by kapil |
  113. Hi kapil,

    Has your wife been diagnosed with diabetes? Because she would like to become pregnant, it’s very important that your wife meet with a physician who specializes in diabetes and/or high risk pregnancy. She will need to lower her A1C, likely through lifestyle changes, but if those are not sufficient, she may need insulin. It’s very important that she get the right medical care prior to becoming pregnant. Your wife should also meet with a dietitian who can help her with a healthy eating plan for blood glucose control and to ensure that she gets adequate nutrition before and during her pregnancy.

    Posted by acampbell |
  114. i got type 1 diabetes 7 years ago and had to inject 4 times a day, six months ago i went for my annual check up and was told by my doctor my diabetes was out of control and i was to have blood tests, which i did,the results came back and i was told by the doctor my pancreas had started to produce insulin again so i am now type 2 and was put on tablets, i dont take insulin any more and check my blood levels up to 6 times a day and they between 6-10, i have lost 2 stone in the past couple of years, could this be the reason

    Posted by steven |
  115. Hi steven,

    You very likely had Type 2 diabetes upon diagnosis, but needed to take insulin to help manage your blood glucose at that time. It’s certainly very likely that your weight loss (which is about 28 pounds) help to increase your insulin sensitivity, which means that your insulin is doing its job — which is to lower your blood glucose. Carrying around too much body weight makes you more insulin resistant, so one of the recommendations to help improve blood glucose control is to lose weight, if you need to. And it worked!

    Posted by acampbell |
  116. I recently diagnosed with type 2 diabetes with Fasting Sugar 257 and PP 400. Then my doctor advised me to take metformin 1000 mg before breakfast. i took it for 10 days. after 3 days of stop taking the medicine, i test BS and it was Fasting 129(12hr fasting) and PP(2hr)215. Now again i talk to my doctor and he told me not to stop medicine and to BS test while on mediciine. After diagnosis initially , i started taking diet which are healthy and diabetic friendly. Also i walk at least 3-4 km per day and my journey to home to office is about( to and fro) 4hr per day including 2 hr standing in metro rail journey.

    Now i request you to guide me what to do next.Shall i start taking the metformin 1000mg or less or i wait for another 15-20 days and start exercise and see the result.

    my father and mother did not have any diabetic history.

    Please advise me. i am confident and can strictly follow the diet programm, excersise, physical activity.

    Posted by ALOK |
  117. Hi ALOK,

    Treatment guidelines for Type 2 diabetes do recommend that most people start off on metformin. Metformin is a very safe and effective medication that can help you reach and stay at your target blood glucose for a longer period of time than just meal planning and exercise alone. Keep in mind that diabetes tends to progress over time. Also, metformin has the added benefit of helping some people lose weight. You’re doing a great job with healthy eating and physical activity — so keep that up! But, it sounds like your doctor would like you to take metformin. I’d suggest that you have another conversation with him, discuss your concerns and your efforts with eating and exercise and together, come up with a plan.

    Posted by acampbell |
  118. thanks a lot for the response. i just forgot to tell you some facts. My HbIAC was 11.8%, my weight reduced from 66kg to 63 kg. my height is 5ft 6inch.So doctors told me to take 1000mg metformin before breakfast only. now my BS level has been reduced from 257 Fasting to 129 Fasting, 400 PP to 215 PP after taking metformin. should i continue to take 1000 mg or reduce it.

    Alok

    Posted by ALOK |
  119. Hi ALOK,

    Again, this is a discussion that you should have with your doctor. You don’t mention what your A1C level is now, but your fasting blood glucose is 129, and the target range is 70 to 130 mg/dl, so you’re right on the border. Also, your post meal blood glucose is 215 (which is down quite a bit from 400!) but the goal is less than 180. In my opinion, you should likely continue to take the metformin, but as I am not a doctor, it’s best to ask him.

    Posted by acampbell |
  120. The comments and data along with high a1c number make a leakly liver with nasty dawn effect most suspicious. Here again discussion with Doctor is correct response.

    The metformin response and dropping of numbers further backs up that issue.

    Posted by jim snell |
  121. Hi,

    refer to my earlier post. my BS level on 15-10-2012 was fasting 257 pp 400, then on 28-10-2012 fasting 129 pp 215, on 11-11-2012 fasting 147 PP 195.Now i have started taking gylocment gp 1 forte(metformin 1000 mg) one tablet before breakfast and one Maxum tablet(Antioxidant, minerals and vitamin) with lunch as advised by Docotor.

    Now my question is that
    1. whether the maxum tablet is required and is it safe?
    2. i am also taking 1.5km per day walk and jogging every morning empty stomach.
    3. my diet is mainly on wheat, dal, vegetable, sprouted lentils, legumes etc.
    4. i am also taking emty stomach garlic and okra water.
    5. i am using 1/4 teaspoon of cinamon powder on my diet at dinner.

    please let me know is there any side effect of okra water if i take along with metformin.

    Alok

    Posted by ALOK |
  122. Hi Alok,

    Metformin is a very safe medicine, so you should continue to take it as long as your doctor has prescribed it. Also, your daily walking/jogging and your diet seem to be helping your blood glucose control, too. I don’t know enough about the antioxidant that you’re taking, but antioxidants, as well as the garlic and okra water, are unlikely to help with your blood glucose. The cinnamon may help, however. To the best of my knowledge, the okra water should not interfere with your metformin, but it probably won’t be of much help in terms of your diabetes.

    Posted by acampbell |
  123. Refer to my post above. i was detected diabetes with Fasting BS 257 PP400 ON two month back on OCT 2012. after that i started taking metformin 1000 mg once a day before breakfast as advised by my doctor.

    After two months, on DEC 2012 when i checked the BS, it was Fasting 109 and PP 91( I HAVE TAKEN THE MEDICINE BEFORE PP TEST).

    My routine morning walk and jogging for 30-45 mintues is continuing and also taking high fibre diet with vegetables.

    please advice my whether can i reduce the metformin 1000mg to 500 mg now? what to do next.Also please let me know whether to take medicine before test or not.

    MY KFT, LFT AND CBC count are within range except my uric acid is 7.5.

    Alok

    Posted by ALOK |
  124. Hi Alok,

    It’s OK to take your metformin before you check your blood glucose. I can’t advise you to decrease your metformin dose — only your doctor can do that. Also, you probably shouldn’t base this decision on just a few blood glucose readings. Wait and see what your next A1C level is before making a change to your treatment plan.

    Posted by acampbell |
  125. Well, Here are my comments:

    a) metformin has a 2.5 hours to full etrength in blood so unless one wait 2.5 hours after ingestion, comments made make sense.

    b) as one who has watched his leaky liver drive BG up and down each time Metformin comes up to strength and 2 hours later falling off ( glucose slowly climbs back up as metformin lets loose of liver; I am fed up with these hugh doses once a day.

    In fact a dose of 500 to 700 mg strung around clock keeps liver arrested and saves greatly on the insulin and exercise without making one sick - 1000mg to 2000mg single doses. Medical science has somehow fixated on the insulin resistance effects of metformin rather than understanding how metformin signals liver to stop leaking out excess glucose. The liver signalling - reduce glucose release -is simply tracking on sufficient metformin in blood to liver up to strong enough dose and has NO BEARING on the metformin residuals that supposedly reduce insulin resistance. Watching with cgms will catch this effect.

    Posted by jim snell |
  126. Thanks for the comment. i have visited my doctor and he has now reduced the dosage to 500mg metformin Glycomet-GP1 Metformin hydrochloride 500
    mg, Glimepiride 1mg before breakfast along with ME 12OD (Salt methylcobalamin extended release and vitamin tablet) one before breakfast. The metformin is sustainable release type.

    HE ASKED ME TO DO Hb1AC after one month to see the result and then to decide the dosage.

    Now pleas let me know what is the methylcobalamin extended release tablet is for and is there any side effect of taking it?

    Alok

    Posted by ALOK |
  127. Hi Alok,

    That sounds like a plan. Metformin is linked to a vitamin B12 deficiency, so your doctor has likely prescribed methylcobalamin, a form of vitamin B12, to help prevent this. Methylcobalamin isn’t the most common form of B12 used, and the extended-release version isn’t always well-absorbed. But there should be few side effects, as B12 is a water-soluble vitamin and isn’t stored in the body.

    Posted by acampbell |
  128. refer to my earlier post. on 25-01-2013 i tested my Blood Sugar level, it was Fasting 109 (12 hr fasting), PP (99) WITH Medicine after 2 hr of breakfast.HB1AC is 6.5

    Now i am taking metformin 500mg with methylcobalamin as prescribed by my doctor.i am yet to visit the doctor with the latest report.

    Initially on Oct 2012, my Fasting was 257 and PP 400 with HBIAC 11.8.

    please advise me what to do next.

    alok

    Posted by ALOK |
  129. Hi alok,

    My advice is to keep a record of your blood glucose results, which indicate that the metformin is working, and bring them to your next doctor’s appointment to discuss if any further changes are needed to your treatment plan.

    Posted by acampbell |
  130. Dear Sir
    I am 46 years of age and my mother is diabetic.
    Few days a ago I did BS fasting at a lab and the reading was 192. On repeat next day at home it was 140. Then I went for HBA1c it was 5.9%. On introducing strict diet control and atleast 45 minutes daily brisk walking, about fifteen days after BS fasting is between 107-111.PP is 129.Am I diabetic? What should I do next? Should I go on medication? I am hypertensive and have LBB over heart rate of 83.I and taking Envas 5mg twice a day and Concor 5mg once a day

    Posted by rakesh |
  131. Hi rakesh,

    I can’t really tell you if you have diabetes or not. However, I would advise you to have another fasting blood glucose done at your doctor’s office (not at home). A fasting blood glucose of 126 or higher, or an A1C of 6.5% or higher is diagnostic of diabetes, but these tests must be repeated to confirm the diagnosis. Your A1C of 5.7% puts you in the “prediabetes” category, so at the very least, you are at risk for getting diabetes. Healthy eating, weight loss (if you need to lose weight), and physical activity are the best ways to help prevent prediabetes from turning into diabetes. Talk with your doctor about whether or not you should take medication, and again, I suggest that you have either a repeat fasting blood glucose or A1C test.

    Posted by acampbell |
  132. Hi, thanks for the good article.. I agree with it especially on the diet and exercise and frequent blood glucose monitor… I’d like to share on my late grandmother experience with controlling her diabetes.. She was diagnosed with diabetes at 25 y.o… And after that, she started watching out for her diet and frequently exercise everyday… She also monitors blood glucose level daily, but she did not take any medicine for diabetes… This was maintained consistently until she’s 75 and died of mouth cancer (she ate betel leave and some spices due to her indian roots and tradition) and not because of diabetes related diseases…

    Posted by Marina |
  133. Hi Amy,

    I started displaying polydipsia, polyuria, fatigue, headache, some abdominal pain, and a general foggy feeling in my head. Got tested and lab work came back as 74 on the glucose, fasting test, a 60 ketone level on urinalysis, and 5.7 on A1C test.

    My BMI is around 19 so I’m not overweight but I do live a fairly sedentary lifestyle. I have a genetic predisposition to Type 2 diabetes (paternal side).

    Does this mean I’m prediabetic or diabetic? Regardless, I’m wholly committed to changing my lifestyle since this is huge wake-up call.

    Please advise. Thank you.

    hds

    Posted by hds |
  134. Hi hds,

    Given that your A1C of 5.7 is right on the cusp for being considered prediabetes, I’d suggest that you ask your provider to repeat the A1C test. It’s recommended that fasting glucose and A1C tests be repeated before diagnosing prediabetes or diabetes. In the meantime, given your family history, it’s certainly appropriate for you to focus on your lifestyle (healthy eating, regular physical activity), as we know that lifestyle measures can help to prevent Type 2 diabetes.

    Posted by acampbell |
  135. Thank you for your response. I will do that.

    hds

    Posted by hds |
  136. I eat 2 meals/day then apple or red grapefruit in evenings. I have learned to do this because I can tell that when I eat “dinner” it is not digested by 10pm. My digestion is obviously slow and I don’t eat lg meals ever. a.m.FBS 130+ and I’m about to start metformin 2/day.
    I believe there must be a connection here that Dr.are missing: slow digestion/elev a.m.FBS.

    Do you think there could be a connection?
    I sometimes take hydrochloric acid pill before eating lunch (usually only if I’m going out)and THEN, I will be hungry in evening & want dinner. I haven’t conducted an experiment testing my a.m.FBS after having HCl night b4, but probably should.

    I’m female, 62, 20 lbs overwt. bloodtype A+ (which I think may underlie the slow digestion/lack of enzymes as I age)

    acampbell, ur comments above are really informative - THANK YOU

    Posted by lolly |
  137. Hi lolly,

    I’m glad you’ve found the site to be helpful! As far as your digestion: There are several factors that can slow digestion. The first one is a condition called gastroparesis (which is more common in people with diabetes). This condition results in slow stomach emptying, and can often cause diarrhea and/or constipation, bloating, and nausea. Another factor is a high fat intake. Fat takes at least several hours to digest, so eating a fatty meal (pizza, fried foods) can really slow digestion. High blood glucose levels can slow digestion as well. I’m not aware of evidence linking blood type and digestion, however. Try eating smaller, lower fat meals earlier in the evening. Also, keep in mind that it’s normal for digestion to take several hours. It’s also common for people with diabetes to have higher fasting blood glucose levels, and that often is not related to what you ate the night before. Hormones kick in in the early morning hours that can raise blood glucose. Increasing your metformin is a wise idea. If you think you have issues with digestion, consider meeting with a dietitian to review your food choices.

    Posted by acampbell |

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